Antidepressants and other mood-altering drugs dangerous with very little benefit, expert argues — (The National Post)

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The National Post

Sharon Kirkey   More from Sharon Kirkey | @sharon_kirkey

May 12, 2015

Antidepressants and other psychiatric drugs provide so little benefit that doctors could stop writing 98 per cent of all prescriptions without causing harm, a Danish expert argues this week in a leading medical journal piece that has renewed the debate around fast-growing prescriptions of mood-altering drugs.

Dr. Peter Gotzsche argues in the British Medical Journal that flawed and biased industry-funded drug trials have overplayed the benefits and understated the deaths from antidepressants, tranquilizers and antipsychotics.

Canadian leaders in psychiatry call the claims misleading, misguided and dangerous. But Gotzsche calculates that psychiatric drugs contribute to the deaths “of more than half a million people” aged 65 and older in the Western world alone, including deaths due to suicide.

“Their benefits would need to be colossal to justify this,” he writes in the BMJ, “but they are minimal.”

New guidelines are needed to reflect that psychiatric drugs — including ADHD drugs — should “almost exclusively be used” in acute situations in the short-term, “and always with a firm plan for tapering off,” writes Gotzsche.

“Widespread withdrawal clinics” will also be needed to help people come off their drugs, slowly and safely, he said.

In Canada, 47.1 million prescriptions for antidepressants alone were filled by retail drugstores in 2014, representing sales totaling $1.91-billion, according to prescription drug-tracking firm IMS Brogan.

Montreal psychiatry professor Dr. Joel Paris says 11 per cent of the population is on antidepressants, but ‘‘the prevalence of severe mood disorders is nowhere near that high …. It’s the old thing of, if you have a hammer, everything looks like a nail.”

But Paris says Gotzsche is dangerously exaggerating the problem, especially around suicide and mortality. And antidepressants and other psychiatric drugs, when used properly, are an “essential part of psychiatric practice,” said Paris, past chair of psychiatry at McGill University.

The problem, he says, isn’t that the drugs are not effective for very sick people — “they clearly are” — but rather that they are over-prescribed for people whose problems “are closer to normal.”

Newer antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, a class that includes Prozac, Paxil and their generic cousins, ranked 8th, and “other antidepressants” ranked 10th out of the top 10 drug classes by total public drug program spending in Canada in 2012, according to the Canadian Institute for Health Information.

Drug companies were ordered a decade ago to add a warning of increased risk of suicidal thinking to SSRIs, and research has shown that the difference between the blockbuster drugs and placebo is not nearly as significant as doctors once thought.

However, Paris said that, in the case of severe depression, people “absolutely need these medications.”

But the drugs are also being wildly overprescribed, he said, a phenomenon he attributes to a loosening of the criteria for major depression, a tendency to keep “pushing, switching and combining” drugs when the first doesn’t work, and a rush to treat “unhappiness” and other normal bouts of misery.

“There all kinds of legitimate questions here and I’ve written about them myself,” Paris said. “But to say that 98 per cent of it is worthless is just a ridiculous exaggeration.”

Dr. Roumen Milev, head of the department of psychiatry at Queen’s University in Kingston, said Gotzsche is doing harm “by painting everything black.” Anti-depressants prevent suicide, because they treat depression, said Milev.

“If somebody now goes around and tells these people, ‘stop your meds’ — we had that before. Remember the Church of Scientology, or the anti-psychiatry movement, back in the 1970s? This is another incarnation through more scientific dressing,” Milev said.

“I know these medications are not a panacea,” he said. “But for the people for whom they work, they’re the saviour.”

In a counter argument in the BMJ, Dr. Allan Young, a past director of psychiatry at the University of British Columbia and now a professor of mood disorders at King’s College London, argues psychiatric drugs are “rigorously examined” for safety and efficacy before allowed on the market, and that they are as beneficial as other treatments used for “common, complex medical conditions.”

Gotzsche is an internal medicine specialist and one of the founders of the Cochrane Collaboration, a world-renowned network of medical researchers who pool and summarize medical evidence for doctors. He was among the first scientists to question the benefits of breast cancer screening using mammography.